Clinical Pearls: A JOMI review by AO’s YCC

As an occasional feature of AO CONNECT, articles from The International Journal of Oral and Maxillofacial Implants (JOMI) — the official journal of AO— are reviewed from the viewpoint of a member of the Academy’s Young Clinicians Committee (YCC). Today’s “JOMI Clinical Pearls” by Dr. Nicole Olivares are pulled from Volume 32, Number 2, 2017.

This study sought to assess the loosening of interchangeable one-piece abutments in internal-connection type implants after cyclic loading.

Four abutment groups were assessed using a Straumann tissue-level implant in combination with either a Straumann solid abutment (S), Southern Implants solid abutment (SI), Implant Direct solid abutment (ID), or Blue Sky Bio regular platform abutment (BSB). The implant was fitted to a secure jig, abutments torqued to the manufactures’ recommendations, and a custom hemispherical loading member was attached to evenly distribute the force. The load was delivered at 30 degrees to the long axis of the implant to mimic chewing. Tightening torques were calculated for each abutment and loading commenced for half a million cycles at 25N with a load with a frequency of 3 Hz. After loading, removal torques were measured.

See Figures 1 and 3 below:

Group S showed a higher mean removal value, followed by group SBS, SI and ID respectively. Group S and BSB had a significantly lower mean removal rate than the other abutments.

Bottom Line: Although copy abutments are marketed as interchangeable they may perform differently in some situations and there is potential risk for complication. This may be due to different physical and chemical properties however more investigation is needed. This study suggests that using an abutment made by the same implant manufacturer could decrease the complication of screw loosening.

The Impact of Implant Design, Defect Size, and Type of Superstructure on the Accessibility of Nonsurgical and Surgical Approaches for the Treatment of Peri-implantitis (David Polak, PhD, DMD1/Efrat Maayan, DMD2/Tali Chackartchi, DMD3)

Peri-implantitis is a major concern today and despite several suggested protocols, treatment outcomes are often unpredictable. This study aimed to clarify the effects of implant design, defect size and type of superstructure in both the non-surgical and surgical treatment of peri-implantitis.

Conical and straight implants were compared (MIS Implants). The straight implant had a design with microthreads in the coronal portion while the conical implant did not. Both designs were sand-blasted and acid etched. The implants were painted with a bio-film like, white correction material. They were placed in a bone model with prepared defects that were either 3 mm or 5 mm deep. Two superstructures were compared in each scenario: healing abutment verses provisional crown. In the non-surgical scenario, a mucosa-like material was placed over the implants.

See Figure 3 below:

Treatment was performed with a standard ultrasonic tip for 120 seconds. The surgical scenarios were repeated under the same parameters with the plastic covering removed, to mimic surgical therapy. These experiments were completed by two periodontists and a postgraduate student and repeated twice.

The implants were removed and buccal, lingual, mesial, and distal aspects were photographed and quantification of the remaining biofilm-like material was done using imaging software. Implant conditions were grouped by non-surgical verses surgical, shallow or deep defect for both the straight and conical implants.

See Figure 4 below:

In all scenarios, the non-surgical approach was less effective in cleaning the implant surface as compared to surgical treatment regardless of defect depth. In the shallow defects, the amount of residue was lower for the conical-type implant, whereas in the deeper defects, the straight-type implant showed lower residue. Most debris was found in the inter-thread valleys and microthreads, if present, and was greater towards the apical aspect of the implant. The implant design, superstructure, or operator experience did not appear to affect the ability to clean the implants.

Bottom Line: Surgical access was more effective at removing biofilm from an implant with a bony defect in this experimental situation. Future studies are needed to explore the effects of implant design, superstructure and operator experience as well as exploring existing and novel approaches for biofilm removal.

About the AuthorDr. Nicole Olivares obtained her doctorate in dentistry from the University of California, Los Angeles. She went on to complete her specialty training in periodontics at Oregon Health and Science University. Dr. Olivares is a Diplomate of the American Board of Periodontology. She is in private practice in San Francisco, California with a focus on dental implants, periodontal plastic surgery and disease treatment.